MEDICARE: NORTHEASTERN WASHINGTON EYECARE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist

General Provider Information

NPI Number	:	1811647605
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEASTERN WASHINGTON EYECARE

Provider Business Mailing Address
First Line	:	102 S OAK ST
Second Line	:
City	:	COLVILLE
State	:	WA
Zip	:	99114-2846
Country	:	US
Telephone Number	:	509-684-5278
Fax Number	:	509-684-3268

Provider Business Practice Location Address
First Line	:	102 S OAK ST
Second Line	:
City	:	COLVILLE
State	:	WA
Zip	:	99114-2846
Country	:	US
Telephone Number	:	509-684-5278
Fax Number	:	509-684-3268

Authorized Official
Title or Position	:	OWNER DOCTOR
Name	:	KYLE CRANCE
Credential	:	OD
Telephone Number	:	509-844-1343

Provider Enumeration Date	:	03/25/2022
Last Update Date	:	03/25/2022

Similar Medicare Providers

1053308007 — CHERYL M FENNO O.D.
Practice Location Address:

102 S OAK ST
COLVILLE, WA
99114-2846

Practice Phone: 509-684-5278
Practice Fax:

1366439242 — MICHAEL GREGORY FENNO O.D.
Practice Location Address:

102 S OAK ST
COLVILLE, WA
99114-2846

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Practice Fax:

1154463669 — FENNO EYE CLINICS INC., P.S.
Practice Location Address:

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99114-2846

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1366920167 — STEVEN W PRATER LCSW
Practice Location Address:

165 E HAWTHORNE AVE
COLVILLE, WA
99114-2629

Practice Phone: 509-684-4597
Practice Fax: 509-684-5286

1295692580 — JAMIE V MORRIS RN
Practice Location Address:

982 E COLUMBIA AVE STE 201
COLVILLE, WA
99114-3316

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Practice Fax:

1891792966 — STEVENS COUNTY
Practice Location Address:

165 E HAWTHORNE AVE
COLVILLE, WA
99114-2629

Practice Phone: 509-684-4597
Practice Fax: 509-684-5286

Directions to “NORTHEASTERN WASHINGTON EYECARE ” Practice Location

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